Social Security Disability (SSDI & SSI) for Fibromyalgia

At the present time, Social Security does not have a disability listing for the condition known as fibromyalgia, also known as fibromyositis. (Social Security's disability listings provide the approval criteria for a number of different impairments, ranging from amputations to seizure disorder). Nevertheless, many claimants with fibromyalgia apply for disability, and many go on to win their cases. For this reason, fibromyalgia disability claimants who are denied benefits initially should not give up on their case. Instead, they should pursue their disability claim through the appeals process, keeping in mind how the Social Security Administration (SSA) views this particular impairment. 

How Does Social Security View Fibromyalgia?

Unfortunately, when a disability claims examiner receives a case in which the only allegation (reason for disability) is fibromyalgia, the outlook for an initial approval is not good. In fact, disability examiners will generally give little weight to a claim of fibromyalgia unless another condition is involved, such as arthritis or degenerative disc disease.

Why is this? Part of the problem has to do with the nature of fibromyalgia itself. Fibromyalgia is an impairment whose symptoms are largely subjective and whose causes are not fully understood. And though it may be a legitimate disability in and of itself, because its symptoms and speculated causes vary so much from one person to the next, disability examiners are never sure how to classify such cases. Therefore, it helps a Social Security case considerably if a fibromyalgia diagnosis has been made in conjunction with another diagnosis, preferably one of a musculoskeletal nature.

For example, if a claimant makes a disability claim and the chief impairments are fibromyalgia and rheumatoid arthritis, or fibromyalgia and degenerative disc disease, the fibromyalgia allegation will automatically carry more weight. This is because, in such cases, fibromyalgia will be seen as a logical and plausible extension to what are generally thought of as "more proven" impairments.

Additionally, and this is very significant, a fibromyalgia diagnosis made by an orthopedist or rheumatologist will seem credible to a disability examiner and, as a result, will strengthen a Social Security disability claim, in contrast to situations where the fibromyalgia diagnosis has been made by an internist or family doctor. When a primary care physician renders a fibromyalgia diagnosis without a corroborative diagnosis by a specialist, to a disability examiner, it may seem that the doctor gave the patient a label for lack of a better way to diagnose a patient's pain. And, unfortunately, this is often the case. Many times when family doctors are unable to find reasons for the pain their patients feel, they diagnose "fibromyalgia" as the cause. Disability examiners see this routinely in the records they review.

Meeting the Criteria for Fibromyalgia

While disability examiners may not take fibromyalgia seriously at the initial level of consideration, the courts that have heard disability appeals have indicated more of a willingness to approve disability benefits for severe fibromyalgia. Courts (and the SSA) have stated that they will rely on criteria issued by the American College of Rheumatology (ACR)to determine whether an applicant has fibromyalgia, and thus has a "medically determinable impairment." The ACR criteria to be used in determining whether you have fibromyalgia include:

• Chronic widespread pain, and

• Tender points sites in 11 of 18 tender point areas of the body. A list of the tender points can viewed in the ACR's criteria for the classification of fibromyalgia.

The courts have also agreed that you have a better chance of convincing the SSA that you have fibromyalgia if your doctor has attempted to rule out other diseases, and your various doctors agree that you have fibromyalgia.  

Getting an RFC Assessment

If the SSA believes that you have fibromyalgia, according to the ACR's criteria, and that it is severe and will last at least 12 months, it must give you an RFC assessment. An RFC assessment is an evaluation of your ability to perform various levels of work; for example, if you can't lift more than 10 pounds, you will be given a sedentary RFC.

The SSA bases your RFC on your medical records, opinions from doctors and specialists, and statements from you and family members. In assessing your RFC, the SSA will rely on your doctor's opinion as to how long you can stand, sit, and walk, how much you can lift, and how well you can focus and remember instructions. In addition to giving your an RFC level, the assessment will include limitations that may rule out various jobs. For instance, if you need to take frequent rest breaks, this would limit the types of jobs you can do. If you can't use your hands for fine motor movements, this would further limit the types of jobs you can do.

After creating your RFC, the SSA will compare it to the types of jobs available for someone with your RFC level and limitations. If your RFC rules out all jobs, you would be found disabled. For more information, see our articles on how Social Security uses your RFC.

Getting Help

More so than in other cases, hiring a lawyer to appeal a denial of benefits for fibromyalgia can really help your case, since disability lawyers know the latest court rulings on disability for fibromyalgia and will be able to find errors made by the claims examiner or judge and use them to your advantage.

Also, since many people with fibromyalgia also have chronic fatigue syndrome (CFS), reading our article on disability for CFS may help you with your case. Fibromyalgia is also similar to myofascial pain syndrome (MPS), although MPS doesn't usually involve specific trigger points for pain.

What else can someone with this condition do to help tip the scales in their favor when applying for disability? Read our article Tips on Winning Disability With Fibromyalgia.